Abstract:

Adults with HIV are living longer due to earlier diagnosis and increased access to antiretroviral medications.
Therefore, fewer young children are being orphaned and instead, are being cared for by parents who know they
are HIV positive, although they may be asymptomatic. Presently, it is unclear whether the psychological
functioning of these young children is likely to be affected or, alternatively, whether it is only when a mother is ill,
that children suffer adverse effects. We, thus, aimed to compare the behavior and psychological functioning of
young children (aged 6 10 years) of HIV-positive and HIV-negative mothers. We also aimed to examine the
association between HIV status disclosure and child outcomes. This study uses cross-sectional data from the
baseline assessment of a randomized controlled trial conducted in Tshwane, South Africa. Participants (n 509)
and their children were recruited from area health clinics. Among the 395 mothers with HIV, 42% reported
symptoms of HIV disease. Multivariate linear regression models suggested that after adjusting for sociodemographic
characteristics, children of HIV-positive mothers had significantly greater externalizing behaviors
than children of HIV-negative mothers. Importantly, children whose mothers were symptomatic had greater
internalizing and externalizing behaviors compared with children of HIV-negative mothers, but this was not true
for children of asymptomatic mothers. Additionally, among children of HIV-positive mothers, those who had
been told their mothers were sick compared with children who had been told nothing had less internalizing and
externalizing behaviors and improved daily living skills. This study, therefore, provides evidence that maternal
HIV disease can affect the behaviors of young children in South Africa but, importantly, only when the mothers
are symptomatic from their disease. Furthermore, results suggest that disclosure of maternal illness but not HIV
status was associated with improved behavior and psychological functioning among young children.